Malaria is the leading cause of morbidity and mortality in Africa, this disease is caused by infection from an organism plasmodium through a bite from the anopheles mosquito. The organism multiplies in the liver attacking red blood cells resulting in cycles of fever, chills, and sweats accompanied by anaemia (reduction in blood cells). It can lead to death due to damage to vital organs and interruption of blood supply to the brain. 

The majority of worldwide 1.5 - 2.5 million estimated annual deaths occur in sub-Saharan Africa.

Symptoms include:

  • a high temperature (fever)
  • sweats and chills
  • headaches
  • vomiting
  • muscle pains
  • diarrhoea

Symptoms usually appear between 7 and 18 days after becoming infected, but in some cases, the symptoms may not appear for up to a year, or occasionally even longer. It should be noted that not all cases of fever are Malaria, and it is best to have a test done before taking anti-malaria drugs. Abuse of anti-malaria drugs leads to drug resistance which makes the drug less effective on the organism later on. 

Malaria can be prevented by eradicating mosquitoes or preventing bites, simple ways to do this include; 

  • Cut down grasses and clear swamps around your house
  • Sleep under a mosquito net (preferably the treated ones)
  • Spray your room with good insecticides twice weekly
  • Window nets have been found to be helpful in preventing bites
  • Mosquitoes are attracted by sweat, so it is useful to take a bath before going to bed and making your bedroom cool

See your physician once you notice these symptoms (fever, joint pain, headache, bitter taste in the mouth and fatigue). Malaria is a serious illness that can get worse very quickly and can be fatal if not treated promptly.

It can also cause serious complications, including;

  • severe anaemia – where red blood cells are unable to carry enough oxygen around the body, leading to drowsiness and weakness
  • cerebral malaria – in rare cases, the small blood vessels leading to the brain can become blocked, causing seizures, brain damage and coma

The effects of malaria are usually more severe in pregnant women, babies, young children and the elderly. 

Malaria infection during pregnancy has substantial risks for the mother, her fetus and the neonate. Intermittent preventive treatment (IPT) of malaria in pregnancy is a full therapeutic course of antimalarial medicine given to pregnant women at routine antenatal care visits. IPT reduces maternal malaria episodes, maternal and fetal anaemia, placental parasitaemia, low birth weight, and neonatal mortality.

Common cold as the name depicts is everywhere, also known as nasopharyngitis or acute coryza, is a viral infectious disease of the upper respiratory tract which affects the nose primarily causing sneezing, sore throat, cough and runny nose. 

It is usually self-resolving after about seven to ten days. The only possible ways to reduce the spread of the viruses are physical measures such as hand washing, reducing contact with anyone with symptoms and wearing of masks amongst health workers.

In general, a person becomes contagious from a few days before their symptoms begin until all of their symptoms have gone. This means most people will be infectious for around two weeks.

You can catch the virus from an infectious person by; 

  • touching an object or surface contaminated by infected droplets and then touching your mouth, nose or eyes
  • touching the skin of someone who has the infected droplets on their skin and then touching your mouth, nose or eyes
  • inhaling tiny droplets of fluid that contain the cold virus – these are launched into the air when an infected person coughs or sneezes

Colds spread most easily among groups of people in constant close contact, such as families and children in school or daycare facilities. They're also more frequent during the rainy season, although it's not clear exactly why. A number of different viruses can cause a cold, so it's possible to have several colds one after the other, as each one may be caused by a different virus

There's no cure for a cold, but you can look after yourself at home by;

  • resting, drinking plenty of warm fluids and eating healthily
  • taking over-the-counter painkillers, such as paracetamol or ibuprofen, to reduce any fever or discomfort
  • using decongestant sprays or tablets to relieve a blocked nose
  • trying remedies such as gargling salt water and sucking on menthol sweets/lozenges.

Many painkillers and decongestants are available from pharmacies without a prescription. They're generally safe for older children and adults to take, but might not be suitable for babies, young children, pregnant women, people with certain underlying health conditions, and those taking certain other medications. Speak to a pharmacist if you're unsure.

You can take some simple steps to help prevent the spread of a cold. For example;

  • wash your hands regularly, particularly before touching your nose or mouth and before handling food
  • always sneeze and cough into tissues – this will help prevent the virus-containing droplets from your nose and mouth entering the air, where they can infect others; you should throw away used tissues immediately and wash your hands 
  • clean surfaces regularly to keep them free of germs 
  • use your own cup, plates, cutlery and kitchen utensils
  • don't share towels or toys with someone who has a cold

It's been suggested that vitamin C, zinc and garlic supplements may help reduce your risk of getting a cold, but there's currently not enough strong evidence to support this.

Human immunodeficiency virus (HIV) is a slowly replicating retrovirus that causes acquired immunodeficiency syndrome (AIDS); an infectious disease in which progressive decline and failure of the human immune system leads to life-threatening opportunistic infections.

HIV is most commonly transmitted through having unprotected sex with someone with HIV who isn't taking HIV treatment. Unprotected sex means having sex without taking HIV PrEP or using condoms.

HIV can also be transmitted by; 

  • sharing infected needles and other injecting equipment
  • an HIV-positive mother to her child during pregnancy, birth and breastfeeding

All pregnant women are ideally offered an HIV test and if the virus is found, they can be offered treatment which virtually eliminates risk to their child during pregnancy and birth.

People who take HIV treatment and whose virus level is undetectable can't pass HIV on to others. Although there is no cure for HIV yet, people living with HIV who are regular and compliant with their medication/treatment should have normal lifespans and live in good health. However, without treatment, people with HIV will eventually become unwell. 

The only way to find out if you have HIV is to have an HIV test. This involves testing a sample of your blood or occasionally saliva for signs of the infection. Some services, including HIV or sexual health charities, may provide saliva tests. Saliva tests that indicate a person may have HIV will need to be confirmed through a blood test.

Treatments for HIV are now very effective, enabling people with HIV to live long and healthy lives. Medication, known as antiretrovirals, work by stopping the virus replicating in the body, allowing the immune system to repair itself and preventing further damage. These medicines usually come in the form of tablets, which must be taken every day. HIV is able to develop resistance to a single HIV drug very easily, therefore, most people with HIV take a combination of 3 antiretrovirals (although some people take 1 or 2) and it's vital that the medications are taken every day as recommended by your doctor. Taking a number of different drugs doesn’t always mean taking many tablets though as some drugs are combined together into one tablet.

For people living with HIV, taking effective antiretroviral therapy (where the HIV virus is "undetectable" in blood tests) can sometimes prevent you from passing on HIV to sexual partners. It's extremely rare for a pregnant woman living with HIV to transmit it to their babies, provided they receive timely and effective antiretroviral therapy (ART) and medical care. 

HIV can be prevented by the following practice;

  • Proper use of condom during sexual intercourse
  • Proper screening of blood before transfusion
  • Avoid sharing share objects
  • Safe injection practices
  • Proper circumcision of male children
  • Post-exposure prophylaxis to health workers and rape victims

This is a term for inflammation of the uterus, fallopian tubes and/or ovaries as it may progress and lead to infertility; Route of spread is usually via sexual intercourse or via post abortal sepsis and intrauterine device insertion. If untreated it could lead to infertility or ectopic pregnancy. 

Several different types of bacteria can cause PID, including the same bacteria that cause the sexually transmitted infections (STIs) gonorrhea and chlamydia. What commonly occurs is that bacteria first enter the vagina and cause an infection. As time passes, this infection can move into the pelvic organs.

PID can become extremely dangerous, even life-threatening, if the infection spreads to your blood. If you suspect that you may have an infection, see your doctor as soon as possible.

Your risk of pelvic inflammatory disease increases if you have gonorrhea or chlamydia​ ​, or have had an STI before. However, you can develop PID without ever having an STI.

Other factors that can heighten your risk for PID include:

Some women with pelvic inflammatory disease don’t have symptoms. For the women who do have symptoms, these can include:

Pelvic inflammatory disease can cause mild or moderate pain. However, some women have severe pain and acute symptoms, such as:

If you have severe symptoms, call or go see your doctor immediately or go to the emergency room. The infection may have spread to your bloodstream or other parts of your body. This can be life-threatening.

Below are ways to prevent PID;

  • Abstinence /healthy sexual behaviour
  • Use of barrier methods such as condoms or diaphragm
  • Avoid vaginal douching
  • Good personal hygiene; never wear panties twice
  • A periodic pelvic examination and STI testing to screen for symptomless PID
  • See a gynaecologist once you notice any abnormal vaginal discharge
  • Treating partners to prevent reinfection or spread to other people

This is also known as high blood pressure and it simply means that the blood pressures in the arteries are elevated and this requires the heart to work harder than normal to circulate blood through the vessels. Blood pressure is summarized by two measures: systolic (when the heart contracts) and diastolic (when the cardiac muscles are relaxed). High blood pressure is present when the pressure is 140/90mmHg and above (for the general public), this is a major risk factor for stroke, heart failure, myocardial infarction and chronic kidney disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it can affect nearly everyone. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes.​ This can result in vision loss.
  • Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
  • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
  • Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

This disease can be prevented by the following;

  • Maintain normal body weight for adults; body mass index of 20-25kg/m2
  • Reduce dietary salt intake
  • Engage in regular aerobic exercise daily
  • Limit alcohol consumption
  • Eat lots of fruits and vegetables
  • Regular check up. KNOW YOUR NUMBERS

Acute diarrhoeal disease is a very common water and food-borne disease, caused by a wide range of enteric organisms, symptoms include passage of loose stools, fever, abdominal cramps and sometimes vomiting. There are many different causes of diarrhoea, but a bowel infection (gastroenteritis) is a common cause in both adults and children.

Gastroenteritis can be caused by:

  • viruses – such as norovirus or rotavirus
  • bacteria – such as campylobacter and Escherichia coli (E. coli), which are often picked up from contaminated food 
  • parasites – such as a parasite that causes giardiasis, which is spread in contaminated water

These infections can sometimes be caught during travel abroad, particularly to areas with poor standards of public hygiene. This is known as ​travellers' diarrhoea​.

Diarrhoea can also be the result of anxiety, a food allergy, medication, or a long-term condition, such as irritable bowel syndrome (IBS). Most cases of diarrhoea clear up after a few days without treatment, and you may not need to see your GP.

However, diarrhoea can lead to dehydration, so you should drink plenty of fluids – small, frequent sips of water – until it passes. It's very important that babies and small children do not become dehydrated. Your pharmacist may suggest you use an oral rehydration solution (ORS) if you or your child are particularly at risk of dehydration.

You should eat solid food as soon as you feel able to. If you're breastfeeding or bottle-feeding your baby and they have diarrhoea, you should try to feed them as normal.

Stay at home until at least 48 hours after the last episode of diarrhoea to prevent spreading any infection to others. Medications to reduce diarrhoea, such as loperamide, are available. However, these are not usually necessary, and most types should not be given to children.

It's important to see your GP if the diarrhoea is particularly frequent or severe, or associated with other symptoms, such as;

  • blood in your or your child's stool
  • persistent vomiting
  • a severe or continuous stomach ache
  • weight loss
  • signs of dehydration – including drowsiness, passing urine infrequently and feeling lightheaded or dizzy
  • your stool is dark or black – this may be a sign of bleeding inside your stomach

You should also contact your GP if your or your child's diarrhoea is particularly persistent, as this may be a sign of a more serious problem. In most cases, diarrhoea should pass within about a week.

The ways to prevent diarrhoea include;

  • Avoid consumption of uncovered foods such as fruits cut and exposed
  • Drink only potable water
  • Avoid eating foods from unsanitary food vendors and local restaurants
  • Wash your hands before eating
  • Wash your hand after you use the toilet

By Dr Akinde

Indigestion also known as dyspepsia is an upper abdominal discomfort which can be a pain or burning sensation usually associated with bloating, nausea, flatulence, belching, or an uncomfortable fullness soon after meals. Indigestion is not a disease, but rather the symptoms experienced.

Indigestion is common and as many as 1 in 4 people have dyspepsia nearly six times yearly. However, the symptoms experienced may vary from person to person occurring from every day or intermittently.

Occasionally, indigestion may be a symptom of another disease. It also occurs frequently during pregnancy although it usually presents as heartburn caused by acid reflux. The symptoms in indigestion are commonly provoked by eating. 

Common causes include overeating or eating too fast, fatty, greasy or spicy foods, too much caffeine, alcohol, chocolate or carbonated beverages; smoking, anxiety, stress, certain antibiotics, pain relievers and iron supplements.

Gastrointestinal diseases that can cause indigestion are Gastroesophageal Reflux Disease (GERD), peptic ulcers, inflammation of the stomach (Gastritis), gallstones, pancreatitis and rarely esophageal or stomach cancer.

Only about 10% of patients present to the clinicians for care as most people are able to identify specific foods that provoke their indigestion. Other symptoms that prompt an immediate visit to the doctor include pain on swallowing, unexplained weight loss, recurrent vomiting, passing black stool or bloody stool, yellowness of eyes, a palpable swelling in the abdomen.

Indigestion is diagnosed primarily based on typical symptoms and exclusion of other gastrointestinal and non-gastrointestinal diseases and occasionally psychiatric illness. Upper gastrointestinal endoscopy is indicated to rule out injury of the stomach lining especially in patients presenting with atypical symptoms or with heartburn for more than 5 years especially patients over 50 years.

Further tests are indicated in some settings such as screening for H​ . pylori ​infection, stool tests, a blood count and other laboratory tests. Imaging is usually performed if abnormalities are found.

Lifestyle modifications may help ease indigestions and some recommendations are avoiding foods that trigger indigestion, eating five or six small meals a day instead of three large meals, maintaining a healthy weight, reducing or eliminating the use of alcohol and caffeine, avoiding certain pain relievers such as aspirin, ibuprofen and naproxen, exercising regularly, controlling stress and anxiety.

Medications may be prescribed if indigestion persists despite lifestyle medications. Over the counter, antacids are usually first-line and are best taken after eating. Other options for treatment include proton pump inhibitors, H-2 receptor antagonist, prokinetics, antibiotics to eradicate H​ . pylori ​if indicated and anti-anxiety medications.

Alternative therapies that may help ease indigestion, though none has been well studied, include herbal therapies with peppermint and ginger, acupuncture, hypnotherapy, cognitive behavioural therapy and meditation.

Since indigestion is very common, almost all doctors, especially family physicians treat patients with indigestion. However, if they are unable to provide adequate treatment the patient may be referred to an internist or gastroenterologist.

Acne is a common skin condition that affects most people at some point. It causes spots, oily skin and sometimes skin that's hot or painful to touch.

Acne most commonly develops on the:

  • face – this affects almost everyone with acne
  • back – this affects more than half of people with acne
  • chest – this affects about 15% of people with acne

There are 6 main types of spot caused by acne:

  • blackheads – small black or yellowish bumps that develop on the skin; they're not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring)
  • whiteheads – have a similar appearance to blackheads, but may be firmer and won't empty when squeezed
  • papules – small red bumps that may feel tender or sore
  • pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus
  • nodules – large hard lumps that build up beneath the surface of the skin and can be painful
  • cysts – the most severe type of spot caused by acne; they're large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring

How to manage acne

  • Don't wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse
  • Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse
  • Don't try to "clean out" blackheads or squeeze spots. This can make them worse and cause permanent scarring
  • Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin)
  • Completely remove make-up before going to bed
  • If dry skin is a problem, use a fragrance-free, water-based emollient
  • Regular exercise can't improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising, as sweat can irritate your acne
  • Wash your hair regularly and try to avoid letting your hair fall across your face

Although acne can't be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies. If you develop acne, it's a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended – but be careful, as this can bleach clothing.

If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription.Even mild cases of acne can cause distress. If your acne is making you feel very unhappy or you can't control your spots with over-the-counter medication, see your GP.

Also see your GP if you develop nodules or cysts, as they need to be treated properly to avoid scarring. Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring.

Treatments can take up to 3 months to work, so don't expect results overnight. Once they do start to work, the results are usually good.

Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. There's no evidence that diet, poor hygiene or sexual activity play a role in acne.

Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms.

ARLD doesn't usually cause any symptoms until the liver has been severely damaged. When this happens, symptoms can include:

  • feeling sick
  • weight loss
  • loss of appetite
  • yellowing of the eyes and skin (jaundice)
  • swelling in the ankles and tummy
  • confusion or drowsiness
  • vomiting blood or passing blood in your stools

This means ARLD is frequently diagnosed during tests for other conditions, or at a stage of advanced liver damage.

If you regularly drink alcohol to excess, tell your GP so they can check if your liver is damaged.

With the exception of the brain, the liver is the most complex organ in the body. Its functions include:

  • filtering toxins from the blood
  • aiding digestion of food
  • regulating blood sugar and cholesterol levels
  • helping fight infection and disease

The liver is very resilient and capable of regenerating itself but prolonged alcohol misuse (drinking too much) over many years can reduce its ability to regenerate. This can result in serious and permanent damage to your liver.

ARLD is getting more common on the continent, the number of people with the condition has been increasing over the last few decades as a result of increasing levels of alcohol misuse.

There's currently no specific medical treatment for ARLD. The main treatment is to stop drinking, preferably for the rest of your life. This reduces the risk of further damage to your liver and gives it the best chance of recovering.

If a person is dependent on alcohol, stopping drinking can be very difficult. However, support, advice and medical treatment may be available through local alcohol ​support services​.

A liver transplant may be required in severe cases where the liver has stopped functioning and doesn't improve when you stop drinking alcohol.

You'll only be considered for a liver transplant if you've developed complications of cirrhosis​ ​, despite having stopped drinking. All liver transplant units require a person to not drink alcohol while awaiting the transplant, and for the rest of their life.

The most effective way to prevent ARLD is to stop drinking alcohol or stick to the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week

A unit of alcohol is equal to about half a pint of normal-strength lager or a pub measure (25ml) of spirits.

Even if you've been a heavy drinker for many years, reducing or stopping your alcohol intake will have important short- and long-term benefits for your liver and overall health.

Appendicitis is a painful swelling of the appendix. The appendix is a small, thin pouch about 5-10cm (2-4 inches) long. It's connected to the large intestine, where stools (faeces) are formed.

Nobody knows exactly why we have an appendix, but removing it isn't harmful.

Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go.

Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe.

Pressing on this area, coughing, or walking may all make the pain worse. You may lose your appetite, feel sick, and occasionally experience diarrhoea​ ​ .If you're experiencing abdominal pain that is gradually getting worse, contact your hospital or doctor immediately. You should call for an ambulance if you have sudden pain that continues to get worse and spreads across your abdomen.

These are signs your appendix may have burst, which can lead to potentially life-threatening complications.

In most cases of appendicitis, the appendix needs to be surgically removed as soon as possible. The operation is most commonly performed as keyhole surgery (laparoscopy), which involves making several small cuts in your abdomen, through which special surgical instruments are inserted. Open surgery, where a larger, single cut is made in the abdomen, is usually carried out if the appendix has burst or access is more difficult.

Most people make a full recovery from an appendectomy in a couple of weeks, although strenuous activities may need to be avoided for up to 6 weeks after open surgery. 

If you have appendicitis, you may also have other symptoms, including:

  • feeling sick (nausea)
  • being sick
  • loss of appetite
  • diarrhoea
  • a high temperature (fever) and a flushed face

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness.

The severity of these symptoms varies from person to person. Asthma can be controlled well in most people most of the time, although some people may have more persistent problems. Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an "asthma attack", although doctors sometimes use the term "exacerbation".

Severe attacks may require hospital treatment and can be life threatening, although this is unusual.

Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).

Common asthma triggers include:

  • house dust mites
  • animal fur
  • pollen
  • cigarette smoke
  • exercise
  • viral infections

Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. Speak to your GP if you think your symptoms are worse at work and get better on holiday. The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition.

Asthma can develop at any age, including in young children and elderly people. While there is no cure for asthma, there are a number of treatments that can help control the condition.

Treatment is based on two important goals, which are:

  • relieving symptoms 
  • preventing future symptoms and attacks

For most people, this will involve the occasional – or, more commonly, daily – use of medications, usually taken using an inhaler. However, identifying and avoiding possible triggers is also important.

You should have a personal asthma action plan agreed with your doctor or nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.

A personal asthma action plan (see below) will help you recognise the initial symptoms of an asthma attack, know how to respond, and when to seek medical attention.

In most cases, the following actions will be recommended:

  1. Take one to two puffs of your reliever inhaler (usually blue) immediately.
  2. Sit down and try to take slow, steady breaths.
  3. If you do not start to feel better, take two puffs of your reliever inhaler (one puff at a time) every two minutes (you can take up to 10 puffs) – this is easier using a spacer, if you have one.
  4. Call an ambulance. If an ambulance does not arrive within 10 minutes and you are still feeling unwell, repeat step three.

If your symptoms improve and you do not need to call an ambulance, you still need to see a doctor or asthma nurse within 24 hours.

If you are admitted to hospital, you will be given a combination of oxygen, reliever and preventer medicines to bring your asthma under control.

Your personal asthma action plan will need to be reviewed after an asthma attack, so reasons for the attack can be identified and avoided in future

Bronchitis is an infection of the main airways of the lungs (bronchi), causing them to become irritated and inflamed.

The main symptom is a cough​ ​, which may bring up yellow-grey mucus (phlegm). Bronchitis may also cause a sore throat and wheezing.Most cases of bronchitis can be treated easily at home with rest, non-steroidal anti-inflammatory drugs (NSAIDs) and plenty of fluids.

You only need to see your doctor if your symptoms are severe or unusual – for example, if:

  • your cough is severe or lasts longer than three weeks
  • you have a constant fever (a temperature of 38°C or above) for more than three days
  • you cough up mucus streaked with blood
  • you have an underlying heart or lung condition, such as ​asthma or ​​   heart failure

Your doctor may need to rule out other lung infections, such as pneumonia​ ​, which has symptoms similar to those of bronchitis. If your doctor thinks you may have pneumonia, you will probably need a chest X-ray, and a sample of mucus may be taken for testing. If your doctor thinks you might have an undiagnosed underlying condition, they may also suggest a pulmonary function test. You will be asked to take a deep breath and blow into a device called a spirometer, which measures the volume of air in your lungs. Decreased lung capacity can indicate an underlying health problem.

In most cases, bronchitis will clear up by itself within a few weeks without the need for treatment. This type of bronchitis is known as "acute bronchitis". While you are waiting for it to pass, you should drink lots of warm fluids and get plenty of rest.

In some cases, the symptoms of bronchitis can last much longer. If symptoms last for at least three months, it is known as "chronic bronchitis". There is no cure for chronic bronchitis, but there are several medications to help relieve symptoms. It is also important to avoid smoking and smoky environments, as this can make your symptoms worse.

The bronchi are the main airways in your lungs, which branch off on either side of your windpipe (trachea). They lead to smaller and smaller airways inside your lungs, known as bronchioles. The walls of the bronchi produce mucus to trap dust and other particles that could otherwise cause irritation.

Most cases of acute bronchitis develop when an infection causes the bronchi to become irritated and inflamed, which causes them to produce more mucus than usual. Your body tries to shift this extra mucus through coughing.

Smoking is the most common cause of chronic bronchitis. Over time, tobacco smoke can cause permanent damage to the bronchi, causing them to become inflamed.

Pneumonia is the most common complication of bronchitis. It happens when the infection spreads further into the lungs, causing air sacs inside the lungs to fill up with fluid. 1 in 20 cases of bronchitis leads to pneumonia.

People at an increased risk of developing pneumonia include:

  • elderly people
  • people who smoke
  • people with other health conditions, such as heart, liver or kidney disease ● people with a weakened immune system 

Mild pneumonia can usually be treated with antibiotics in an outpatient clinic. More severe cases may require admission to hospital.

Constipation is a common condition that affects people of all ages. It can mean that you're not passing stools regularly or you're unable to completely empty your bowel.

Constipation can also cause your stools to be hard and lumpy, as well as unusually large or small. The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a long-term (chronic) condition that causes significant pain and discomfort and affects quality of life.

It's often difficult to identify the exact cause of constipation. However, there are a number of things that contribute to the condition, including:

  • not eating enough fibre, such as fruit, vegetables and cereals
  • a change in your routine or lifestyle, such as a change in your eating habits
  • ignoring the urge to pass stools
  • side effects of certain medications
  • not drinking enough fluids
  • anxiety​ or ​depression

In children, poor diet, fear about using the toilet and problems with toilet training can all lead to constipation.

You may be able to treat constipation yourself by making simple changes to your diet and lifestyle (see below). If these changes don't help and the problem continues, you should see your doctor. Also speak to your GP if you think your child might be constipated.

Diet and lifestyle changes are usually recommended as the first treatment for constipation. This includes gradually increasing your daily intake of fibre, making sure you drink plenty of fluids, and trying to get more exercise. If these aren't effective, your doctor may prescribe an oral laxative medication that can help you empty your bowels. Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.

Making the diet and lifestyle changes mentioned above can also help to reduce your risk of developing constipation in the first place. Giving yourself enough time and privacy to pass stools comfortably may also help, and you should try not to ignore the urge to go to the toilet.

For most people constipation rarely causes complications, but people with long-term constipation can develop:

  • haemorrhoids (piles)
  • faecal impaction (where dry, hard stools collect in the rectum) ● bowel incontinence (the leakage of liquid stools)

Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning.

If you have insomnia, you may:

  • find it difficult to fall asleep
  • lie awake for long periods at night
  • wake up several times during the night
  • wake up early in the morning and not be able to get back to sleep
  • not feel refreshed when you get up
  • find it hard to nap during the day, despite feeling tired
  • feel tired and irritable during the day and have difficulty concentrating

Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time.

Persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.

On average, a "normal" amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less. What's most important is whether you feel you get enough sleep, and whether your sleep is good quality. You're probably not getting enough good-quality sleep if you constantly feel tired throughout the day and it's affecting your everyday life.

It's not always clear what triggers insomnia, but it's often associated with:

  • stress and anxiety
  • a poor sleeping environment – such as an uncomfortable bed, or a bedroom that's too light, noisy, hot or cold
  • lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed
  • mental health conditions – such as ​depression and​   ​schizophrenia
  • physical health conditions – such as heart problems, other sleep disorders and long-term pain
  • certain medicines – such as some ​antidepressants,epilepsy​ medicines and ​steroid medication

There are a number of things you can try to help yourself get a good night's sleep if you have insomnia, these include:

  • setting regular times for going to bed and waking up
  • relaxing before bed time – try taking a warm bath or listening to calming music
  • using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
  • avoiding caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed
  • not watching TV or using phones, tablets or computers shortly before going to bed 
  • not napping during the day
  • writing a list of your worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning

Some people find over-the-counter sleeping tablets helpful, but they don't address the underlying problem and can have troublesome side effects.

Your doctor will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems. They'll probably also discuss things you can do at home that may help to improve your sleep.

Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time. This is because they don't treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time.

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head, usually associated with nausea, vomiting and increased sensitivity to light or sound.

Migraine is a common health condition, affecting around one in every five women and around one in every fifteen men. They usually begin in early adulthood.

There are several types of migraine, including:

  • migraine with aura – where there are specific warning signs just before the migraine begins, such as seeing flashing lights
  • migraine without aura – the most common type, where the migraine occurs without the specific warning signs
  • migraine aura without headache, also known as ​silent migraine – where an aura or other migraine symptoms are experienced, but a headache doesn't develop

Some ​common migraine triggers​ include:

  • Stress. When you’re stressed, your brain releases chemicals that can cause the blood vessel changes that can lead to a migraine.
  • Foods. Some foods and drinks, such as aged cheese, alcohol, and food additives like nitrates (in pepperoni, hot dogs, lunch meats) and monosodium glutamate (MSG) may be responsible for up to 30% of migraines.
  • Caffeine. Getting too much or withdrawing from it can cause headaches when the level in your body abruptly drops. Blood vessels seem to get used to caffeine, and when you don’t have any, you may get a headache. Caffeine itself can be a treatment for acute migraine attacks.
  • Changes in weather. Storm fronts, changes in barometric pressure, strong winds, or changes in altitude can all trigger a migraine.
  • Skipping meals
  • Changes to your sleep patterns

Some people have migraines frequently, up to several times a week. Other people only have a migraine occasionally. It's possible for years to pass between migraine attacks.

If you suspect a specific trigger is causing your migraines, such as stress or a certain type of food, avoiding this trigger may help reduce your risk of experiencing migraines. It may also help to maintain a generally healthy lifestyle, including regular exercise, sleep and meals, as well as ensuring you stay well hydrated and limiting your intake of caffeine and alcohol.

If your migraines are severe or you've tried avoiding possible triggers and are still experiencing symptoms, your doctor may prescribe medication to help prevent further attacks. It may take several weeks before your migraine symptoms begin to improve.

Sickle cell anemia is one of a group of disorders known as sickle cell disease. Sickle cell anemia is an inherited red blood cell disorder in which there aren't enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels. In sickle cell anemia, the red blood is shaped like sickles or crescent moons. These rigid, sticky cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body.

Sickle cell anemia is caused by a mutation in the gene that tells your body to make the iron-rich compound that makes blood red and enables red blood cells to carry oxygen from your lungs throughout your body (hemoglobin). In sickle cell anemia, the abnormal hemoglobin causes red blood cells to become rigid, sticky and misshapen.

Both mother and father must pass the defective form of the gene for a child to be affected.

If only one parent passes the sickle cell gene to the child, that child will have the sickle cell trait. With one normal hemoglobin gene and one defective form of the gene, people with the sickle cell trait make both normal hemoglobin and sickle cell hemoglobin, that is their blood might contain some sickle cells, but they generally don't have symptoms. They're carriers of the disease, however, which means they can pass the gene to their children.

The main symptoms of sickle cell disease are “sickle cell crises” (very painful episodes affecting different parts of the body), infections, and anaemia.

There are a number of serious problems that can appear suddenly as a result of sickle cell disease. If you experience any of the following symptoms, you should get medical advice immediately:

  • high temperature (a fever) 
  • difficulty breathing
  • drowsiness, confusion, or slurred speech
  • a severe headache, stiff neck, or dizziness
  • skin or lips that are very pale
  • fits (seizures)
  • serious pain that isn't responding to treatments at home
  • sudden swelling in the tummy
  • priapism – a painful erection lasting two hours or more
  • weakness on one or both sides of your body
  • sudden vision loss, or changes in your vision

If you carry the sickle cell trait, seeing a genetic counselor before trying to conceive can help you understand your risk of having a child with sickle cell anemia. They can also explain possible treatments, preventive measures and reproductive options.

Diabetes mellitus, commonly known as diabetes, is a metabolic disease that causes high blood sugar. The hormone insulin moves sugar from the blood into your cells to be stored or used for energy. With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it does make.

Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys, and other organs.

There are a few different types of diabetes:

  • Type 1 diabetes is an autoimmune disease. The immune system attacks and destroys cells in the pancreas, where insulin is made. It’s unclear what causes this attack. About 10 percent of people with diabetes have this type.
  • Type 2 diabetes occurs when your body becomes resistant to insulin, and sugar builds up in your blood.
  • Prediabetes occurs when your blood sugar is higher than normal, but it’s not high enough for a diagnosis of type 2 diabetes.
  • Gestational diabetes is high blood sugar during pregnancy. Insulin-blocking hormones produced by the placenta cause this type of diabetes. 

A rare condition called diabetes insipidus is not related to diabetes mellitus, although it has a similar name. It’s a different condition in which your kidneys remove too much fluid from your body.

The general symptoms of diabetes include:

  • increased hunger
  • increased thirst
  • weight loss
  • frequent urination
  • blurry vision
  • extreme fatigue
  • sores that don’t heal

At the present time, diabetes can't be cured, but it can be treated and controlled. The goals of managing diabetes are to:

  • Keep your blood glucose levels as near to normal as possible by balancing food intake with medication and activity.
  • Maintain your blood cholesterol and triglyceride (lipid) levels as near their normal ranges as possible by decreasing the total amount of fat to 30% or less of your total daily calories and by reducing saturated fat and cholesterol.
  • Control your blood pressure. Your blood pressure should not go over 130/80.
  • Slow or possibly prevent the development of diabetes-related health problems.

You hold the key to managing your diabetes by:

  • Planning what you eat and following a balanced meal plan
  • Exercising regularly
  • Taking medicine, if prescribed, and closely following the guidelines on how and when to take it
  • Monitoring your blood glucose and blood pressure levels at home
  • Keeping your appointments with your health care providers and having laboratory tests as ordered by your doctor

Remember: What you do at home every day affects your blood glucose more than what your doctor can do every few months during your checkups.

Chronic back pain is pain that persists after an injury or surgery where the source is hard to determine. Acute pain can develop into chronic pain for a number of reasons. Once these reasons have been determined through a medical evaluation, treatment can focus on reducing back pain and improving mood and function.

Signs and symptoms of back pain can include:

  • Muscle ache
  • Shooting or stabbing pain
  • Pain that radiates down your leg
  • Pain that worsens with bending, lifting, standing or walking
  • Pain that improves with reclining

Most back pain gradually improves with home treatment and self-care, usually within a few weeks. If yours doesn't improve in that time, see your doctor. In rare cases, back pain can signal a serious medical problem. 

Seek immediate care if your back pain:

  • Causes bowel or bladder problems
  • Is accompanied by fever
  • Follows a fall, blow to your back or other injury

Contact a doctor if your back pain:

  • Is severe and doesn't improve with rest
  • Spreads down one or both legs, especially if the pain extends below the knee
  • Causes weakness, numbness or tingling in one or both legs
  • Is accompanied by unexplained weight loss

Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or excessive drug or alcohol use.

You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics. To keep your back healthy and strong:

  • Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities you might try.
  • Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels. Your doctor or physical therapist can tell you which exercises are right for you.
  • Maintain a healthy weight. Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.
  • Quit smoking.​ Talk to your doctor about ways to quit.

As in all forms of cancer,breast cancer is made of abnormal cells that have grown uncontrollably. Those cells may also travel to places in your body where they aren’t normally found. When that happens, the cancer is called metastatic.

Breast cancer usually begins in a small, confined area in the glands which produce milk (lobular carcinoma) or the ducts (ductal carcinoma), which carry it to the nipple. It can grow larger in the breast and spread through channels to nearby lymph nodes or through your bloodstream to other organs. The cancer may grow and invade tissue around the breast, such as the skin or chest wall. Different types of breast cancer grow and spread at different rates - some take years to spread beyond the breast, while others grow and spread quickly.

Signs and symptoms of breast cancer may include:

  • A breast lump or thickening that feels different from the surrounding tissue
  • Change in the size, shape or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly inverted nipple
  • Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

If you feel a lump or something shows up on a mammogram, your doctor will begin the breast cancer diagnosis process. The doctor will ask questions about your personal and family health history, then they’ll do a breast exam and possibly order imaging tests that create an image of your breast, these include:

  • Ultrasound. This test uses sound waves to make a picture of your breast.
  • Mammogram. This detailed X-ray of the breast gives doctors a better view of lumps and other problems.
  • Magnetic resonance imaging (MRI). This body scan uses a magnet linked to a computer to create detailed images of the insides of your breasts.
  • Biopsy. For this test, the doctor removes tissue or fluid from your breast. They’ll look at it under a microscope to see if cancer cells are present and if so, which type.

If the tests find breast cancer, you and your doctor will develop a treatment plan to get rid of the cancer, to lower the odds that it will come back, as well as to reduce the chance of it moving to outside of your breast. Treatment generally follows within a few weeks after the diagnosis.

The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.

The prostate is a small walnut shaped gland in the pelvis of men. It is located next to the bladder and can be examined by getting a digital rectal exam. Prostate cancer is a form of cancer that develops in the prostate gland. It is one of the top leading causes of cancer deaths for men around the world. About 1 in 9 men will be diagnosed with prostate cancer in their lifetime. Growths in the prostate can be benign (not cancer) or malignant (cancer).

Benign growths like ​benign prostatic hyperplasia (BPH):

  • Are rarely a threat to life
  • Don't invade the tissues around them
  • Don't spread to other parts of the body
  • Can be removed and can grow back very slowly (but usually don't grow back)

Malignant growths (prostate cancer):

  • May sometimes be a threat to life
  • Can spread to nearby organs and tissues (such as the bladder or rectum)
  • Can spread (metastasize) to other parts of the body (like lymph nodes or bone) 
  • Often can be removed but sometimes grow back

Prostate cancer cells can spread by breaking away from a prostate tumor. They can travel through blood vessels or lymph nodes to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors, causing damage where they land.

When prostate cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the bones are actually prostate cancer cells. The disease is ​metastatic prostate cancer​, not bone cancer. For that reason, it's treated as prostate cancer in the bone.

Prostate cancer may cause no signs or symptoms in its early stages.

Prostate cancer that's more advanced may cause signs and symptoms such as:

  • Trouble urinating
  • Decreased force in the stream of urine
  • Blood in semen
  • Discomfort in the pelvic area
  • Bone pain
  • Erectile dysfunction

It's not clear what causes prostate cancer.

Doctors know that prostate cancer begins when some cells in your prostate become abnormal. Mutations in the abnormal cells' DNA cause the cells to grow and divide more rapidly than normal cells do. The abnormal cells continue living, when other cells would die. The accumulating abnormal cells form a tumor that can grow to invade nearby tissue. Some abnormal cells can also break off and spread (metastasize) to other parts of the body.

Factors that can increase your risk of prostate cancer include:

  • Age.​ Your risk of prostate cancer increases as you age.
  • Race. For reasons not yet determined, black men carry a greater risk of prostate cancer than do men of other races. In black men, prostate cancer is also more likely to be aggressive or advanced.
  • Family history. If men in your family have had prostate cancer, your risk may be increased. Also, if you have a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer, your risk of prostate cancer may be higher.
  • Obesity. Obese men diagnosed with prostate cancer may be more likely to have advanced disease that's more difficult to treat

You can reduce your risk of prostate cancer if you:

  • Choose a healthy diet full of fruits and vegetables. Avoid high-fat foods and instead focus on choosing a variety of fruits, vegetables and whole grains. Fruits and vegetables contain many vitamins and nutrients that can contribute to your health.

Whether you can prevent prostate cancer through diet has yet to be conclusively proved. But eating a healthy diet with a variety of fruits and vegetables can improve your overall health.

  • Choose healthy foods over supplements. No studies have shown that supplements play a role in reducing your risk of prostate cancer. Instead, choose foods that are rich in vitamins and minerals so that you can maintain healthy levels of vitamins in your body.
  • Exercise most days of the week. Exercise improves your overall health, helps you maintain your weight and improves your mood. There is some evidence that men who don't exercise have higher PSA levels, while men who exercise may have a lower risk of prostate cancer.

Try to exercise most days of the week. If you're new to exercise, start slow and work your way up to more exercise time each day.

  • Maintain a healthy weight. If your current weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, add more exercise and reduce the number of calories you eat each day. Ask your doctor for help creating a plan for healthy weight loss.

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